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Sacral Stress Fractures

- Discussion:
    - insufficiency frxs of sacrum and pelvis may be confused w/ metastatic lesions, especially if bony resorption occurs at frx ends;
    - these injuries may also occur in patients with known malignant disease who have a sudden onset of pain in the lower back, hip, or groin;
    - they may occur with normal activities such as walking;

- Bone Scan:
    - useful in patients with insufficiency fractures;
    - look for vertical increase in uptake of radionuclide;
    - w/ bilateral fractures, an H-shaped distribution ("Honda sign");
         - pts who have these patterns should have follow-up CT scans through sacrum in order to confirm the diagnosis;

- Management:
    - complete healing may take upto 9 months;
    - patients require protected wt bearing in order to avoid late displacement and possible malunion;
    - patient also need to be protected from sacral decubiti

Occult sacral fractures in osteopenic patients.

Transverse fractures of the sacrum. A report of six cases.

Conservative management of transverse fractures of the sacrum with neurological features. A report of four cases.

Osteoporotic sacral fractures: a clinical study.

Sacral insufficiency fractures: an often unsuspected cause of low back pain.

Insufficiency fractures of the sacrum.

Magnetic resonance appearance of sacral insufficiency fractures.

Spontaneous osteoporotic fracture of the sacrum: an unrecognized syndrome of the elderly.
Unsuspected sacral fractures: detection by radionuclide bone scanning

Detection of osteoporotic sacral fractures with radionuclides.